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High dose adenosine for suboptimal myocardial reperfusion after primary PCI: A randomized placebo‐controlled pilot study
Author(s) -
Stoel Martin G.,
Marques Koen M.J.,
de Cock Carel C.,
Bronzwaer Jean G.F.,
Birgelen Clemens von,
Zijlstra Felix
Publication year - 2007
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21334
Subject(s) - medicine , conventional pci , timi , percutaneous coronary intervention , adenosine , myocardial infarction , cardiology , placebo , anesthesia , alternative medicine , pathology
Objectives: This study was designed to investigate the influence of high dose intracoronary adenosine on persistent ST‐segment elevation after primary percutaneous coronary intervention (PCI). Background: After successful PCI for acute myocardial infarction 40–50% of patients show persistent ST‐segment elevation indicating suboptimal myocardial reperfusion. Adenosine has been studied to ameliorate reperfusion and is frequently used in a variety of doses, but there are no prospective studies to support its use for treatment of suboptimal reperfusion. Methods: We conducted a blinded, randomized, and placebo‐controlled study with high dose intracoronary adenosine in 51 patients with <70% ST‐segment resolution (STRes) after successful primary PCI. All patients were treated with stents and abciximab. Results: Immediately after adenosine, significantly more patients showed optimal (>70%) STRes compared with placebo (33% versus 9%, P < 0.05). Mean STRes was higher after adenosine (35.4% versus 23.0%, P < 0.05). In addition, TIMI frame count was significant lower (15.7 versus 30.2, P < 0.005), Myocardial Blush Grade was higher (2.7 versus 2.0, P < 0.05) and resistance index was lower in the adenosine group (0.70 versus 1.31 mm Hg per ml/min, P < 0.005). Conclusions: Intracoronary adenosine accelerates recovery of microvascular perfusion in case of persistent ST segment elevation after primary PCI. © 2007 Wiley‐Liss, Inc.